Clinical Results and Toxicity for Short-course Preoperative Radiotherapy and Total Mesorectal Excision in Rectal Cancer Patients

Overview

Journal J Radiat Res

Publisher Oxford University Press

Specialties Environmental Health
Oncology
Radiology

Date 2014 Oct 25

PMID 25341424

Citations 6

Authors

Florian Sterzing

Frieder Hoehle

Alexis Ulrich

Alexandra Jensen

Jurgen Debus

Marc Muenter

Affiliations

Soon will be listed here.

Abstract

Short-course preoperative radiotherapy (SCPRT) is an alternative method to chemoirradiation for patients with Stage II and III rectal cancer when no downsizing is needed, but there is still widespread reluctance to use this method because of fear of side effects from high-fraction doses. This paper reports on a single institution patient cohort of operated rectal cancer patients after SCPRT, evaluated for chronic adverse effects, local control, progression-free survival and overall survival. Altogether, 257 patients were treated with SCPRT and surgery including total mesorectal excision (92% total mesorectal excision = TME) between 2002 and 2009. Local control and survival were analyzed. Chronic adverse effects for 154 patients without local relapse were evaluated according to the NCI-CTCAE version 4.0 classification, with a median follow-up of 48 months. We found a 5-year disease-free survival (DFS) and overall survival (OS) of 71%. The 5-year estimated local control (LC) rate was 94%. A positive resection margin was found in 4% of the patients and was significantly correlated with decreased DFS, OS and LC. Chronic adverse effects were reported by 58% of the patients, of which 10% were Grade 3 toxicities. The most frequent Grade 2 toxicity was stool incontinence (13%). Sexual dysfunction was found in 36% of the patients (31% Grade 1 or 2, and only 5% Grade 3). SCPRT combined with TME produced excellent LC rates together with a low rate of high-grade chronic adverse effects.

Citing Articles

Long-term outcomes and prognostic factors of short-course radiotherapy (SCRT) in rectal cancer: a monocentric retrospective study.

Facondo G, Belotti F, Rotondi M, Vullo G, Fiorelli S, Mossa S Discov Oncol. 2024; 15(1):645.

PMID: 39531153 PMC: 11557790. DOI: 10.1007/s12672-024-01529-5.

A single arm phase 2 clinical trial of YIV-906 with neoadjuvant concurrent chemo-radiation therapy in patients with locally advanced rectal cancer.

Verma N, Johung K, Kortmansky J, Zaheer W, Lacy J, Cecchini M J Gastrointest Oncol. 2024; 15(3):1050-1059.

PMID: 38989411 PMC: 11231844. DOI: 10.21037/jgo-24-23.

Short-course preoperative radiotherapy increases pelvic fracture risk in rectal cancer.

Vesa V, Jaana M, Ia K, Anu C, Heikki M, Raija R Clin Transl Radiat Oncol. 2023; 42:100656.

PMID: 37457020 PMC: 10339188. DOI: 10.1016/j.ctro.2023.100656.

Overcoming radioresistance in WiDr cells with heavy ion irradiation and radiosensitization by 2-deoxyglucose with photon irradiation.

Hasse F, Koerber S, Prigge E, Liermann J, von Knebel Doeberitz M, Debus J Clin Transl Radiat Oncol. 2019; 19:52-58.

PMID: 31517070 PMC: 6733777. DOI: 10.1016/j.ctro.2019.08.003.

Is there a need for neoadjuvant short-course radiotherapy in T3 rectal cancer with positive lymph node involvement? A single-center retrospective cohort study.

Rasanen M, Renkonen-Sinisalo L, Mustonen H, Lepisto A World J Surg Oncol. 2019; 17(1):139.

PMID: 31395058 PMC: 6688332. DOI: 10.1186/s12957-019-1670-0.

References

Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietkau R . Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004; 351(17):1731-40. DOI: 10.1056/NEJMoa040694. View

Lange M, Marijnen C, Maas C, Putter H, Rutten H, Stiggelbout A . Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer. 2009; 45(9):1578-88. DOI: 10.1016/j.ejca.2008.12.014. View

Ngan S, Burmeister B, Fisher R, Solomon M, Goldstein D, Joseph D . Randomized trial of short-course radiotherapy versus long-course chemoradiation comparing rates of local recurrence in patients with T3 rectal cancer: Trans-Tasman Radiation Oncology Group trial 01.04. J Clin Oncol. 2012; 30(31):3827-33. DOI: 10.1200/JCO.2012.42.9597. View

Bujko K, Nowacki M, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M . Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg. 2006; 93(10):1215-23. DOI: 10.1002/bjs.5506. View

Frykholm G, Isacsson U, Nygard K, Montelius A, Jung B, Pahlman L . Preoperative radiotherapy in rectal carcinoma--aspects of acute adverse effects and radiation technique. Int J Radiat Oncol Biol Phys. 1996; 35(5):1039-48. DOI: 10.1016/0360-3016(96)00229-5. View

Breukink S, van Driel M, Pierie J, Dobbins C, Wiggers T, Meijerink W . Male sexual function and lower urinary tract symptoms after laparoscopic total mesorectal excision. Int J Colorectal Dis. 2008; 23(12):1199-205. DOI: 10.1007/s00384-008-0547-4. View

Kulu Y, Buchler M, Ulrich A . [Radiotherapy-associated morbidity and mortality in rectal surgery]. Chirurg. 2013; 84(11):951-6. DOI: 10.1007/s00104-013-2515-y. View

Guckenberger M, Saur G, Wehner D, Sweeney R, Thalheimer A, Germer C . Comparison of preoperative short-course radiotherapy and long-course radiochemotherapy for locally advanced rectal cancer. Strahlenther Onkol. 2012; 188(7):551-7. DOI: 10.1007/s00066-012-0131-2. View

Folkesson J, Birgisson H, Pahlman L, Cedermark B, Glimelius B, Gunnarsson U . Swedish Rectal Cancer Trial: long lasting benefits from radiotherapy on survival and local recurrence rate. J Clin Oncol. 2005; 23(24):5644-50. DOI: 10.1200/JCO.2005.08.144. View

10.

Hulsmans F, Tio T, Fockens P, Bosma A, Tytgat G . Assessment of tumor infiltration depth in rectal cancer with transrectal sonography: caution is necessary. Radiology. 1994; 190(3):715-20. DOI: 10.1148/radiology.190.3.8115617. View

11.

Sebag-Montefiore D, Bujko K, Valentini V . Rectal cancer multidisciplinary management: evidences and future landscape. Radiother Oncol. 2009; 92(2):145-7. DOI: 10.1016/j.radonc.2009.06.026. View

12.

Pietrzak L, Bujko K, Nowacki M, Kepka L, Oledzki J, Rutkowski A . Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: report of a randomised trial. Radiother Oncol. 2007; 84(3):217-25. DOI: 10.1016/j.radonc.2007.07.007. View

13.

Peeters K, Marijnen C, Nagtegaal I, Kranenbarg E, Putter H, Wiggers T . The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg. 2007; 246(5):693-701. DOI: 10.1097/01.sla.0000257358.56863.ce. View

14.

Ho V, Lee Y, Stein S, Temple L . Sexual function after treatment for rectal cancer: a review. Dis Colon Rectum. 2010; 54(1):113-25. DOI: 10.1007/DCR.0b013e3181fb7b82. View

15.

Sartori C, Sartori A, Vigna S, Occhipinti R, Baiocchi G . Urinary and sexual disorders after laparoscopic TME for rectal cancer in males. J Gastrointest Surg. 2011; 15(4):637-43. DOI: 10.1007/s11605-011-1459-0. View

16.

Hendren S, OConnor B, Liu M, Asano T, Cohen Z, Swallow C . Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg. 2005; 242(2):212-23. PMC: 1357727. DOI: 10.1097/01.sla.0000171299.43954.ce. View

17.

Tekkis P, Cornish J, Remzi F, Tilney H, Strong S, Church J . Measuring sexual and urinary outcomes in women after rectal cancer excision. Dis Colon Rectum. 2009; 52(1):46-54. DOI: 10.1007/DCR.0b013e318197551e. View

18.

Lange M, den Dulk M, Bossema E, Maas C, Peeters K, Rutten H . Risk factors for faecal incontinence after rectal cancer treatment. Br J Surg. 2007; 94(10):1278-84. DOI: 10.1002/bjs.5819. View

19.

Myerson R, Garofalo M, El Naqa I, Abrams R, Apte A, Bosch W . Elective clinical target volumes for conformal therapy in anorectal cancer: a radiation therapy oncology group consensus panel contouring atlas. Int J Radiat Oncol Biol Phys. 2009; 74(3):824-30. PMC: 2709288. DOI: 10.1016/j.ijrobp.2008.08.070. View

20.

Peeters K, van de Velde C, Leer J, Martijn H, Junggeburt J, Kranenbarg E . Late side effects of short-course preoperative radiotherapy combined with total mesorectal excision for rectal cancer: increased bowel dysfunction in irradiated patients--a Dutch colorectal cancer group study. J Clin Oncol. 2005; 23(25):6199-206. DOI: 10.1200/JCO.2005.14.779. View